Varadkar announces ten key actions for Medical Card System

Minister for Health Leo Varadkar has welcomed steps by the HSE to enhance the operation of the medical card scheme and make it more sensitive to people’s needs, especially arrangements relating to the issuing of medical cards on a discretionary basis.

The HSE is taking ten actions to improve the operation of the medical card system, particularly for people with significant medical needs:

• An enhanced assessment process which takes into account the burden of an illness or a condition;
• The greater exchange of information between the medical card central assessment office and the local health offices;
• People with a serious illness who hold a discretionary card can also be reassured that they will retain their card pending implementation of the actions to improve the operation of the scheme;
• The power of GPs to extend medical cards in difficult circumstances will be strengthened;
• A clinical advisory group is being established by the HSE to develop guidance on assessing applications involving significant medical conditions;
• The default position for medical cards given to people with terminal illnesses is that they will no longer be reviewed;
• The HSE will be empowered to provide people with therapies or appliances if that’s what they need, even in the absence of a medical card;
• The HSE will develop a single, integrated process for people to apply for a medical card, a GP visit card, the Long-Term Illness scheme, and the Drugs Payment Scheme;
• Access points will be established around the country in health offices to support and assist people to make applications;
• The Department and the HSE will consider the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

Minister Lynch said: “The HSE is comprehensively reforming how the medical card scheme operates so that it will be easier for people to understand and will provide a high-quality customer service. People with a serious illness who hold a discretionary card can also be reassured that they will retain their card pending implementation of the actions to improve the operation of the scheme.”

Minister Varadkar said: “The medical card controversy of last summer required the Government to reconsider how the whole system works. Having done so, with the help of the Expert Group, we have concluded that a financial means-test remains the fairest way to assess eligibility. But we also need an enhanced assessment process which takes into account the burden of an illness or a condition. From now on, wider discretion and greater humanity will be exercised in such cases.

“The default position for medical cards given to people with terminal illnesses is that they will no longer be reviewed. The HSE will be empowered to provide people with therapies or appliances if that’s what they need, even in the absence of a medical card, and the power of GPs to extend medical cards in difficult circumstances will be strengthened.”

The new measures build on recommendations set out in two reports which were also published today – the report of the Expert Panel on Medical Need for Medical Card Eligibility, and the external review of the Medical Card Process, undertaken by Prospectus and Deloitte.

Tony O’Brien, Director General, HSE, welcomed the publication of two very detailed reports which provide objective insight into the current issues relating to medical cards and charts a pathway to addressing these in a systematic way. “The focus now moves to implementation and close monitoring of progress as part of our overall System Reform Programme and the Service Plan for 2015,” he said.

After consulting with patient advocacy groups, the Expert Panel recommended that a person’s means should remain the main qualifier for a medical card and concluded it would not feasible, desirable, nor ethically justifiable to list medical conditions in priority order as a means of determining medical card eligibility. The Ministers thanked the Expert Panel on Medical Need for Medical Card Eligibility for their work in a highly complex area.

Minister Varadkar said: “The more that I have studied the issue of eligibility for medical cards, the more I have become convinced that the only solution is universal health care. No matter what means-test you apply, whether financial or medical, there will always anomalies and there will always be people just above the threshold. However, I am convinced that this new system will be fairer and more humane than the one it is replacing.”

Further details

• The HSE will ensure a more integrated and sensitive processing of applications, involving greater exchange of information between the central assessment office and the local health offices in relation to people’s medical circumstances and needs. Health and social care professionals such as the family general practitioner, public health nurse, occupational therapist and social worker will be consulted as necessary to ensure that decisions on the award of medical cards are informed by a full appreciation of applicants’ health condition and other circumstances.

• The HSE has appointed a senior manager to lead the reform of the systems for handling medical card application and reviews, with a focus on a high-quality customer service and easy-to-understand information and processes. Improved communications and information will be developed and provided for the public, health sector staff and health advocacy groups to ensure a better understanding of people’s entitlements and the rules of the medical card scheme.

• A clinical advisory group will shortly be established by the HSE to develop guidance on assessing applications involving significant medical conditions so as to take account of the burden involved and the needs arising from the condition and to ensure that appropriate services are provided to people who need them. This guidance will be drawn up by this group over the coming months.

• The HSE will engage with the IMO to encourage and support the use by GPs of the facility to temporarily extend the validity of discretionary medical cards where sensitive renewal is appropriate.

• Other actions that the HSE will progress in the short-term are:

o The development of a single, integrated process for people to apply for a medical card, a GP visit card, the Long-Term Illness scheme, and the Drugs Payment Scheme; and
o The establishment of access points around the country in health offices to support and assist people to make applications.

• The Ministers have also asked the HSE to examine, with the Department of Health, the best way to meet the needs of people with significant medical conditions who need the support of the public health system. This work includes considering the best way to make medical aids and appliances available to persons who do not hold a medical card, the provision of services to children with severe disabilities, and to enable people with particular needs to have these met on an individual basis rather than awarding a medical card to all family members.

• The Ministers will continue to oversee the implementation of these actions and will welcome feedback from service users and stakeholder groups. If further improvements are deemed necessary, these will be considered.